Chiropractors make up half the clinical positions in Ontario’s Rapid Access Clinics for Low Back Pain (RAC-LBP) – a program helping people access appropriate low back pain care faster.

RACs for Low Back Pain to help Ontarians access appropriate low back pain care metrics
Ontario’s Rapid Access Clinics for Low Back Pain (RAC-LBP) program helps people access appropriate low back pain care faster.  They are built on results from the Interprofessional Spine Assessment and Education Clinics (ISAEC) pilot.

How a RAC for LBP Works

First, a medical doctor or nurse practitioner refers a patient to a RAC for LBP. Then the patient meets with an Advanced Practice Provider (APP) in their community. An APP is an experienced chiropractor, physiotherapist and/or a nurse practitioner (NP). During the appointment, the APP provides the patient with:

  • A detailed and in-depth low back pain assessment in a timely manner
  • Education about their condition
  • An evidence-based plan they can follow to manage it

However, if the patient needs more advanced surgical assessment and management, the APP refers them to a RAC Practice Lead, who is within a hospital or family health team. Subsequently, this Practice Lead (who is also a chiropractor, physiotherapist or NP) can provide a more in-depth assessment, order images and/or provide a surgical referral, if required.

Ontario launched RACs in late 2017 and subsequently it expanded them across the province.

Back pain can affect your ability to work, play, and live a happy life. Knowing how to deal with it can make all the difference. Find out how Ontario’s Rapid Access Clinics for Low Back Pain can help.

Are you eligible to refer to the RAC-LBP?

Attention: Family Medicine Physicians, Sports Medicine Physicians, and Family Practice Nurse Practitioners

Have you registered to refer patients to RAC-LBP clinics?

You’re eligible to refer patients to the RAC-LBP but you need to complete the RAC-LBP Registration and an online Onboarding Module first, which is a five to 10-minute and includes an overview of the RAC-LBP Model of Care, as well as the crucial role primary care plays in managing low back pain patients. Then you can obtain your regional referral form.

Click/tap this  RAC-LBP Registration link to register to to refer into this program.

Please note: Only primary care providers (Family Medicine Physician, Sports Medicine Physician, or Nurse Practitioner in a family practice) can currently refer into this program. The current funding model and shared care approach to low back pain management is not recognized for other medical specialist referrals.

How a RAC May Help You Access Appropriate Low Back Pain Care Faster

You may be eligible for the RAC for LBP program to access appropriate low back pain care. However, to be eligible, you should have one of the following:

  • Persistent low back pain and/or related symptoms that do not improve in 6 weeks to 12 months after they start OR
  • Unmanageable, recurring low back pain and/or related symptoms that last less than 12 months when they reoccur

If you believe you are eligible for the RAC for LBP program:

  1. Make an appointment with your family doctor, sports medicine doctor or nurse practitioner to ask about a referral to a RAC for LBP. (Please note: the referring provider needs to register in advance for referral privileges via this Refer to RAC-LBP website.)
  2. If you’re referred to a RAC for LBP, you’ll subsequently meet with an advanced practice practitioner (APP), like a chiropractor, physiotherapist and/or a nurse practitioner. This appointment should be within about four weeks from your referral date on average.
  3. To gain the most value from your time with your APP, please download, and complete this Patient Intake Form. Then, bring it to your appointment.
  4. Then at your appointment, your APP will assess your condition, provide you with useful information about it and give you an evidence-based plan to help you best manage your low back pain. However, if you need further testing or more specialized care, your APP will refer you to a RAC Practice Lead. This Practice Lead will provide a more in-depth assessment, order x-ray/MRI images, and/or provide a surgical referral if needed.

How RACs for LBP Helps Ontarians

The Ontario government-funded RACs for LBP are designed to help in various ways. For example, they can:

  • Decrease the prevalence of unmanageable low back pain
  • Reduce unnecessary diagnostic imaging tests and wait times
  • Reduce unnecessary referrals to specialists

Chiropractors’ Role and Impact

Chiropractors contributed to the ISAEC pilot’s success and are a key part of the RAC for LBP.
  • First, RACs for LBP employ more than 50 chiropractors who work as Advanced Practice Providers (APPs). Most importantly, these APPs are the first and primary point of contact for consulting with referred patients.
  • Second, chiropractors hold seven out of fourteen RAC for LBP Practice Lead positions. As Practice Leads, they support patients that APPs identify as needing more advanced surgical assessment and management.
  • Third, a panel of RAC for LBP practitioners, including surgeons, medical doctors and other providers from hospitals, selects chiropractors for the program. Each selected chiropractor collaborates with these other health care professionals to develop management plans for their shared patients.

The Challenge:

  • In a 2019 study, 41 per cent of Ontario respondents reported having low back pain.¹ Furthermore, it’s estimated that chronic (long-term) low back pain affects 4 to 25 per cent of the population. This scenario depends on the case definition, methodology and study sample.²
  • But most importantly, prior to the RACs for LBP launch, many patients with low back pain waited months for imaging tests or to see a surgical specialist, which they often didn’t need.
  • Then, while waiting, these patients often received limited support and guidance about their condition, treatment options or how to manage their pain. Consequently, when treatment finally came, it might include an opioid prescription for chronic pain, even though there are more appropriate options.

RACs for LBP offer a better way to help Ontarians with low back pain access appropriate care in a timely manner.

Building on Research and Results to Help Ontarians Access Appropriate Low Back Pain Care

The RACs for LBP program builds on the successful Interprofessional Spine Assessment and Education Clinics (ISAEC) program. It was for patients requiring 6 to 12 weeks of care. The Ministry of Health piloted ISAEC in Toronto, Hamilton and Thunder Bay, from 2012 to 2017.³

What patients say about RACs for LBP …

“Knowing that I’ve got somebody I can relate to who can come up with a solution that can make me feel better if I have trouble is comforting. He’s got my back.”

Brian Mandelker, RAC patient, Thornhill, ON

“I am back to my normal mental and emotional state. I still can’t bend over, but I can sit. It is day and night compared to what it was like.”

Lynne Miles, RAC patient, as quoted in the Ottawa Citizen

What medical doctors say about RACs for LBP …

“It [RACs] has made management of lower back pain easier for my patients and it has made this challenging area of medicine easier for me.”

Medical doctor and former president,, Ontario College of Family Physicians, as quoted in the Toronto Star

Are you an OCA member?
Learn why RACs matter to chiropractors and how to get involved

[1] Robinson, S., Sadiq, A., Wadhawan, V. Attitudes of Ontarians Toward Chiropractic Care (PN 10380), Environics Research, June 2019; 7.
[2] Meucci RD, Fassa AG, Faria N.M. Prevalence of chronic low back pain: systematic reviewRev Saude Publica 2015;49.
[3] Rampersaud R. Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC): Patient, Provider and System Impact of an Integrated Model of Care for the Management of Low Back Pain (LBP). International Journal of Integrated Care. 2022.